MEDICARE: MS. BARBARA DIANE EMORY LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA14565	FL

General Provider Information

NPI Number	:	1558539460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA DIANE EMORY LMT

Provider Business Mailing Address
First Line	:	27 BOLLINGBROOK ST
Second Line	:	2ND FLOOR
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4548
Country	:	US
Telephone Number	:	804-722-1720
Fax Number	:	804-722-1721

Provider Business Practice Location Address
First Line	:	1302 WELLINGTON RD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2739
Country	:	US
Telephone Number	:	804-524-0252
Fax Number	:	804-722-1721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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